Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 25MA05879900 | NJ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 25MA05879900 | NJ |
NPI | 1255331849 |
---|---|
Provider Name | Constantinos Aristides Costeas |
First Address | West Orange, NJ 07052-2724 |
Second Address | West Orange, NJ 07052-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 22/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7776306 | (05) | NJ |
G68835 | (02) | NJ |